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e...L._.�,�---,,.. ,� � _ .� <br /> CHART NO. <br /> �u� ��-° �� �_�c�5�����.7—�.�� <br /> Sew�r Applicatoon and Per'r�n;it, _ <br /> �� :�:� 3n �aTE - ��i��i�3 - -- � <br /> 616 40th Pl Utility Account No. � ' <br />, Service Address , <br /> Billing Address 3240 EaBtlnke A ,e E <br /> J0.')U <br /> Gity, State, ZiP ��atcl�[•*+ �°���� Permit Fee $ <br /> Owner Connection Charge <br /> Connection by _ -- Trunk $ <br /> Address Lateral $ <br /> -0- <br /> Total Connection Charge $ <br /> ?hone Utility Deveiopment Fee <br /> Legal Description: <br /> Water $ 224.00 <br /> Lot t� Sewer $ <br /> Block <br /> Total Development Fee $ 224.00 <br /> Plat S� �Ver�,aw <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> — NSEW _ ft. <br /> Type of Permit �u� rinn Approved By <br /> Remarks — <br /> Issued By rb <br /> Customer Signature <br /> IMPOR�ANT! <br /> CAL'e. 1-800-424-5555 48-HOURS . <br /> PRIOR TO DIGGING ` <br /> Inspection By Q`P �L`��� <br /> CAL9. 259-8810 FOR INSPECTION � � �_ sy <br /> Date Inspected <br /> SEC SKETCH AlTACH�� � �. _� -, ; <br /> INSPECTIOPd " ' <br />